The Trump Opioid Plan: the Good, the Bad and the Border
The fight against prescription opioid abuse, heroin, and fentanyl in America continues to intensify. Our political landscape may soon see even more drastic shifts because of it. Controversy and conjecture have surrounded many ideas brought to the table on both sides. Even the President himself has been behind some pretty divisive propositions. Then Monday, President Trump unveiled his plan for combatting the ongoing opioid crisis in America while in New Hampshire.
During his speech, the President talked up a few key elements of his plan; some we have heard of before, and others have only recently become a serious topic of conversation. As the administration puts the final touches on their proposals, we thought should take a look at some of the highlights and see which of his plans could actually work, and why experts and advocates believe others probably won’t.
Arguably, there are some pretty good ideas here… and some pretty bad ones, depending on who you ask.
An Opioid Vaccine
Let’s kick this off on a high note.
The Trump opioid plan includes supporting the search for a vaccine. This honestly seems like a good ambition to get behind, but will it work? Researchers at the Walter Reed Army Institute of Research and the National Institute on Drug Abuse developed an experimental heroin vaccine back in December. So far the compound has been tested with rats and mice. Their latest breakthrough found that antibodies in the vaccine bound to the heroin before crossing the blood-brain barrier. This reaction effectively prevents the euphoric effects of the drug.
While this is an exciting development, it is still a vast leap to go from treating mice to treating humans. We still have a long road ahead before this possible vaccine could be approved. However, more funding and resources from the federal government could make a big difference.
Even so, it is important to note that this vaccine will not be a cure-all answer that fixes everything. After all, we have seen opioid blocking methods before. Drugs like Vivitrol and other implants were also developed to hamper the effects of opioids, and they still haven’t stopped the crisis from growing. Experts are already saying this vaccine will only work in the short term and require repeated doses. It is expected to be an incredibly expensive treatment, and it may only be another variation of the Vivitrol shot. Still, some believe this vaccine, used alongside other treatment methods, could be a crucial tool in fighting opioids.
Big Pharma and Prescription Drugs
The Trump opioid plan also takes a look at prescription opioids. The President acknowledged the contribution of pharmaceutical companies and prescription drugs to the opioid crisis. In his statement, he indicated that this administration support research for opioid alternatives.
“That includes federal funding for the development of non-addictive painkillers.”
In talking about prescription drugs, President Trump said the administration also planned on addressing the issue of overprescribing addictive medications. He even touted the Justice Department’s new task force that may soon be fighting Big Pharma companies in court.
“Our Department of Justice is looking very seriously into bringing major litigation against some of these drug companies. We will bring it at a federal level.”
He acknowledges the recent work at the state level to hold Big Pharma accountable. President Trump said his administration will be working to reduce opioid prescriptions by 1/3 over the next three years. Hopefully, as time goes on there will not only be more accountability to those manufacturing these potent medications, but also more options for the thousands of people suffering from chronic pain who do need pain management.
Commercial Campaign
This show we have seen (fail) before. The crisis probably isn’t going to get fixed with re-runs and reboots.
For a long time, Trump has been talking about creating a media campaign to try and combat the opioid crisis. In his remarks on Monday, the president said,
“We are thinking about doing a really large-scale rollout of commercials that show how bad it is for the kids… Scare them from ending up like the people in the commercials.”
Trump said he would spend a lot of money and direct people to make the commercials depict “pretty unsavory situations” claiming that this strategy has worked before with cigarette smoking.
Sadly, the reality is that we have tried this before. Using anti-drug messaging that specifically targets kids and young adults is exactly what was done with the “Just Say No” ad campaign of the 1980s and early 1990s, and the DARE program of the same period. Neither program was proven to be particularly effective in reducing drug use. Some have even argued it did the opposite and actually intrigued young people into drug use.
This is just one part of the Trump opioid plan that reminds people of the ideas pushed in the failed War on Drugs that already destroyed countless lives and only ended up making the problem worse.
So how will this new campaign be different?
The Border
The President also mentioned the importance of combatting the flow of illicit drugs like fentanyl and heroin into the country. He became particularly energized of course when talking about his proposed border wall with Mexico, saying,
“90% of the heroin in America comes from the southern border, where eventually the Democrats will agree with us and we will build a wall to keep the damn drugs out.”
However, many are not so convinced that the wall will be especially effective in stopping drug traffickers. Support for the wall experiences ups and downs as negotiations over immigration continue. Then the President took the opportunity to scrutinize sanctuary cities, calling out California and claiming these places were harboring the most terrible kinds of criminals, including drug dealers.
If part of the Trump opioid plan is to apply even more pressure to sanctuary cities, we may see more back-and-forth when it comes to compromises on immigration policy reform. Recently the Republicans were using DACA as a bargaining chip with Democrats to get the infamous border wall built, but now Trump says Democrats are holding onto it so they can use the issue during the election cycle.
Death Penalty for Drug Dealers
Now, THIS proposal is the one part of the Trump opioid plan that is causing the most controversy, and understandably so.
UPDATE: Attorney General Jeff Sessions sent out a memo Wednesday officially asking federal prosecutors to pursue the death penalty in drug trafficking cases “dealing in extremely large quantities of drugs”. So the administration is now implementing President Donald Trump’s plan to ramp up “tough on crime” punishments in response to the opioid crisis.
In his speech, the President brought having the death penalty for drug traffickers to the forefront. This is an extreme even some of his supporters believed was more tongue-in-cheek than actual proposed policy. The details on this proposal were still pretty scarce at the time. Some support Trump pushing for the death penalty, saying this punishment would only apply to high volume, kingpin-level dealers. But what we should consider is this:
- The federal death penalty is available for a few drug offenses. This includes violations of the “drug kingpin” provisions in federal law.
- Reports indicate that Trump wants Congress to pass legislation that will reduce the amount of drugs needed to trigger mandatory minimum sentences for traffickers.
So should we assume that the President intends to expand what qualifies as “drug kingpin” activity to make the death penalty easier to enforce? If so, what does that mean exactly? And what does it mean for further enforcing other mandatory minimums?
The Justice Department has said it would seek the death penalty “when appropriate under current law.” While drug-related murder is already a capital offense, no one has ever been executed by those rules. However, President Trump says that he and the Justice Department are working very hard to change the laws. To do so would require an act of Congress, and many believe Congress is highly unlikely to expand the federal death penalty. So will any of this be changing soon?
In his comments, President Trump stated,
“If we don’t get tough on the drug dealers, we are wasting our time. And that toughness includes the death penalty.”
President Trump’s call for the death penalty is being strongly met with condemnation. The proposal’s critics range from treatment advocates to law enforcement officials and civil liberty organizations.
Maria McFarland Sánchez-Moreno, executive director of Drug Policy Alliance, said in a statement,
“If this administration wants to save lives, it needs to drop its obsession with killing and locking people up, and instead focus resources on what works: harm reduction strategies and access to evidence-based treatment and prevention.”
Jesselyn McCurdy, deputy director of the American Civil Liberties Union’s Washington office, said,
“Drug trafficking is not an offense for which someone can receive the death penalty,”
McCurdy is referring to a Supreme Court precedent that puts constraints on using the death penalty for a convicted person who did not commit murder.
Furthermore, there are plenty of arguments that this kind of policy is not practical. Some say it would either be so broad it became unconstitutional, or so specific that it would be obsolete. This aspect of the plan has sparked nationwide debate. Americans everywhere are arguing whether or not a drug dealer should be responsible for the deaths of customers.
Sadly, this is so frustrating because past data does not hold with the idea that getting ‘tough’ on drugs is more effective than offering treatment opportunities. One of the best studies backing this is a 2014 study from Peter Reuter at the University of Maryland and Harold Pollack at the University of Chicago. Researchers determined that while simply prohibiting drugs to some extent does raise their prices, there’s no good evidence that tougher punishments or harsher supply elimination efforts do a better job of driving down access to drugs and substance misuse than lighter penalties.
In fact, many addiction advocates argue that harsher punishments can actually be counter-productive because they end up punishing people who need treatment, not incarceration. So the need for a more comprehensive approach to opioid addiction treatment is paramount. Hopefully, this administration will see the need to focus on support for treatment, instead of a primarily punitive focus.
Trump Opioid Plan on Treatment
This is a critical and commendable element of the Trump opioid plan, and I applaud some of its intentions. However, I wish we could talk a lot more about this and a lot less about captial punishment.
Still, I give them credit for saying they want to increase access to addiction treatment and adopting harm reduction. There isn’t much detail to go on though, as far as how this will happen. One aspect is to increase the use of medications such as methadone and buprenorphine.
As another highlight, Trump also asks Congress to repeal a rule blocking Medicaid payments to larger treatment facilities, which could provide a boost in the billions to inpatient clinics. Hopefully, this is one factor of the Trump opioid plan that will pan out, because one of the biggest issues the US faces with the opioid crisis is a limited access to adequate treatment options. If the White House allows Medicaid to reimburse larger treatment facilities, more people will be able to get effective care. Still, it is unclear how many resources the administration is willing to commit to treatment resources.
Hopefully, the Trump opioid plan will evolve and we will see a resurgence of resources going toward helping get people suffer the help they need. It is understandable to want to curb the rise of addiction through anti-trafficking measures and raising awareness, but we already have thousands and thousands of people struggling every day all over America who need help. Preventive steps are crucial, and the President is trying to push for them. But it is vital that we also give everyone already struggling more of a fighting chance. The possibility of more people having greater access could help create a huge shift.
